Abstract
Kidney transplant in patients with liver cirrhosis and nondialysis chronic kidney disease (CKD) is controversial. We report 14 liver cirrhotic patients who had persistently low MDRD-6 estimated glomerular filtration rate (e-GFR) <40mL/min/1.73m2 for ≥3months and underwent either liver transplant alone (LTA; n=9) or simultaneous liver-kidney transplant (SLKT; n=5). Pretransplant, patients with LTA compared with SLKT had lower serum creatinine (2.5±0.73 vs 4.6±0.52mg/dL, P=.001), higher MDRD-6 e-GFR (21.0±7.2 vs 10.3±2.0mL/min/1.73m2 , P=.002), higher 24-hour urine creatinine clearance (34.2±8.8 vs 18.0±2.2mL/min, P=.002), lower proteinuria (133.2±117.7 vs 663±268.2mg/24h, P=.0002), and relatively normal kidney biopsy and ultrasound findings. Post-LTA, the e-GFR (mL/min/1.73m2 ) increased in all nine patients, with mean e-GFR at 1month (49.8±8.4), 3months (49.6±8.7), 6months (49.8±8.1), 12months (47.6±9.2), 24months (47.9±9.1), and 36months (45.1±7.3) significantly higher compared to pre-LTA e-GFR (P≤.005 at all time points). One patient developed end-stage renal disease 9years post-LTA and another patient expired 7years post-LTA. The low e-GFR alone in the absence of other markers or risk factors of CKD should not be an absolute criterion for SLKT in patients with liver cirrhosis.
Published Version
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